Active NPI
Amy Wilson
- Speech-Language Pathologist
- Springfield, IL
National Provider Identifier
1174965446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.011506
- Practice address
- 2120 West Washington Street
Springfield, IL 62702 - Phone
- (217) 793-4880
- NPI assigned
- Jul 26, 2013
- Last updated
- Jul 26, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.011506 | IL | Primary |
Addresses
Primary practice location
2120 West Washington Street
Springfield, IL 62702
Mailing address
2120 W Washington St
Springfield, IL 62702-4630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.011506 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374796800000",
"number": "1174965446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2120 W WASHINGTON ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627024630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 WEST WASHINGTON STREET",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "62702",
"telephone_number": "217-793-4880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-26",
"last_updated": "2013-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.011506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.